摘要
目的探讨针状肾镜钬激光碎石术中结石周围温度的变化特点。方法2019年9—10月将临床收集的一水草酸钙结石打磨成直径约1 cm大小的类圆形,在肾模型肾盂输尿管连接部断端将结石推入肾盂,形成肾结石模型。由同一名高年资医生行经皮针状肾镜钬激光碎石术,温度记录仪探头置于肾盂内结石周围5 mm处,激光功率采用4 W和8 W,灌注速度分别为0、25、50、100 ml/min,脉宽模式分为短脉宽和长脉宽,激光设备选用第5代EMS激光设备。实时记录结石周围温度变化,每种条件下进行3次重复实验,温度变化值为实验结束时与开始时的温度差值。比较不同功率、不同灌流速度、不同脉宽模式针状肾镜钬激光碎石时结石周围温度的变化差异。结果在钬激光功率为4 W,灌流速度分别为0、25、50、100 ml/min时,长脉宽与短脉宽模式结石周围温度变化值差异均无统计学意义[(3.40±0.30)℃与(2.97±0.15)℃,(1.20±0.30)℃与(1.17±0.21)℃,(0.77±0.21)℃与(0.53±0.15)℃,(0.60±0.10)℃与(0.47±0.06)℃,均P>0.05]。在钬激光功率为8 W,灌流速度分别为0、25、50 ml/min时,长脉宽与短脉宽模式结石周围温度变化值差异均有统计学意义[(8.63±0.06)℃与(5.97±0.25)℃,(2.63±0.06)℃与(1.77±0.25)℃,(2.07±0.31)℃与(0.97±0.06)℃,均P<0.05];在灌流速度为100 ml/min时长、短脉宽模式差异无统计学意义[(0.47±0.06)℃与(0.67±0.12)℃,P>0.05]。在长脉宽模式,灌流速度为0、25、50 ml/min时,4 W与8 W钬激光功率结石周围温度变化值差异均有统计学意义(P<0.05);在灌流速度为100 ml/min时,差异无统计学意义(P>0.05)。结论经皮针状肾镜钬激光碎石术中,在0、25、50 ml/min灌流速度下,钬激光高功率和长脉宽模式较低功率和短脉宽模式结石周围温度变化值大;无论长、短脉宽模式,在碎石功率≤8W、灌流速度≥25ml/min时,碎石过程中结石周围温度变化均不明显,手术安全、可靠。
Objective To investigate the characteristics of local temperature changes around the stones during needle perc nephroscopy holmium laser lithotripsy.Methods In vitro,Choosing a hard-plastic kidney model(the same size as the human kidney),and polishing the monohydrate calcium oxalate stones collected clinically into a round shape with a diameter of about 1 cm.Pushing the stone into the renal pelvis from the broken end of the renal pelvis and ureter junction of the kidney model to form a kidney stone model.The experiment operation was performed by the same senior doctor with needle perc nephroscopy holmium laser lithotripsy.The temperature recorder probe was placed 5 mm around the stones in the renal pelvis.The laser power were selected as 4 W and 8 W,and the perfusion rate were 0,25 ml/min,50 ml/min and 100 ml/min,the pulse width modes are divided into short pulse width and long pulse width.The fifth-generation EMS laser device was selected for the laser equipment.The temperature changes were recorded around the stone in real time.The test was repeated 3 times under each condition.The temperature change value is the temperature difference between the end of the experiment and the beginning.The characteristics and differences of the temperature around the nephrolithiasis treated by needle perc nephroscopy were compared.Results The experiments of each group were successfully completed.When the holmium laser power was 4 W and the perfusion rate was 0,25,50 and 100 ml/min,there was no statistically significant difference in the temperature around the lithotripsy between long pulse width and short pulse width[(3.40±0.30)℃vs.(2.97±0.15)℃,(1.20±0.30)℃vs.(1.17±0.21)℃,(0.77±0.21)℃vs.(0.53±0.15)℃,(0.60±0.10)℃vs.(0.47±0.06)℃,all P>0.05].When the holmium laser power was 8 W and the perfusion speed was 0,25,and 50 ml/min,the difference in temperature around the lithotripsy stones between long pulse width and short pulse width was statistically significant[(8.63±0.06)℃vs.(5.97±0.25)℃,(2.63±0.06)℃vs.(1.77±0.25)℃,(2.07±0.31)℃vs.(0.97±0.06)℃;P<0.05].There was no significant difference when the perfusion rate was 100 ml/min[(0.47±0.06)℃vs.(0.67±0.12)℃,P>0.05].In the long pulse width mode,when the perfusion speed was 0,25,and 50 ml/min,there was statistical difference in the temperature change around the stone with 4 W and 8 W holmium laser power(P<0.05);when the perfusion rate was 100 ml/min,the difference was not statistically significant(P>0.05).Conclusions In needle perc nephroscopy holmium laser lithotripsy,compared with low holmium laser power and short pulse width mode,high holmium laser power and long pulse width can significantly increase the surrounding temperature of the stone at the perfusion rate of 0,25 ml/min,and 50 ml/min.However,regardless of the mode of the pulse width,while the lithotripsy power≤8 W,and the perfusion rate≥25 ml/min,the temperature around the stone does not change significantly during the lithotripsy.This type of operation is safe and reliable.
作者
靳松
肖博
姬超岳
李建兴
Jin Song;Xiao Bo;Ji Chaoyue;Li Jianxing(Department of Urology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2020年第11期861-864,共4页
Chinese Journal of Urology
关键词
肾结石
针状肾镜
局部温度
钬激光
Kidney calculi
Needle perc
Local temperature
Holmium laser
作者简介
通信作者:李建兴,Email:ljxl@sina.com。
